Daonáireamh na hÉireann Census of Population of Ireland ...

Daonáireamh na hÉireannCensus of Population of Ireland

Sunday 10 April 2011

For office use onlyAddress

Census 2011

The 2011 Census will take place on Sunday 10 April and will count all the people and households in the country on that night. It is the twenty-fourth census to be held since 1841. The census results will give a comprehensive picture of the social and living conditions of our people and will assist in planning for the future.

What you need to do

Please keep this form in a safe place and complete it on thenight of Sunday 10 April, Census Night. You should consult the Explanatory Notes on the back page to assist you incompleting the form. Remember to sign the declaration on page 23 and to have your completed form ready for collection by your Enumerator.

Legal obligation to participate

This is a Notice under Section 26 of the Statistics Act 1993. The Census is being taken under the Statistics Act 1993 and the Statistics (Census of Population) Order 2010. Under Sections 26 and 27 of the Statistics Act 1993 you are obliged by law to complete and return this form. Any person who fails or refuses to provide this information or who knowingly provides false information may be subject to a fine of up to €25,000.

Confidentiality is guaranteed

The confidentiality of your census return is legally guaranteed by the Statistics Act 1993. The Central Statistics Office will use the information you provide for statistical purposes only. This includes the production of statistical tables and analytical reports and the selection of samples for some of our surveys.

Your Census Enumerator

Your Census Enumerator will help you if you have any questions about the Census. Please co-operate fully with your Enumerator to help ensure the success of Census 2011.

Thank you for your co-operation.

Gerard O’HanlonDirector General

Féadfar leagan Béarla nó Gaeilge den fhoirm seo a chomhlánú.

Who should complete the Census Form?

The householder or any adult member of the householdpresent on the night of Sunday 10 April should complete this form. A separate Household Form should be completed for every household.

A household is:• one person living alone, or• a group of related or unrelated people living at the same address with common housekeeping arrangements, meaning they share at least one meal a day or share a living or sitting room.

Do you need additional forms?

If there is more than one household at this address, ask yourEnumerator for another Household Form.

If there are more than 6 persons in your household on Sunday10 April, ask your Enumerator for a blue Individual Form for each additional person.

How to complete your Census Form

1. Use a Black or Blue pen.2. Mark boxes like this .3. If you make a mistake, do this and mark the correct box.

Where you are required to write in an answer please useBLOCK CAPITAL LETTERS and leave one space between each word. Continue on to a new line if a word will not fit, for example:

Have your form ready for collection

Your Enumerator will return between Monday 11 April andMonday 9 May to collect your completed form.

If your form has not been collected by 9 May, please return itfully completed to Central Statistics Office, PO Box 2011,Freepost 4726, Swords, Co. Dublin.

H O T E L R E C E

P T I O N I S T

Household Form

Central Statistics Office

EH01

CountyCode

EnumerationArea Code

Small AreaCode D. No. Males Females Total

ABSENTpersons

Number of persons PRESENT

Address

What type of accommodationdoes your household occupy?

Mark one box only.

A whole house or bungalow that is:

1 Detached

2 Semi-detached

3 Terraced (including end of terrace)

A flat or apartment (includingduplexes) that is self-contained:

4 In a purpose-built block

5 Part of a converted house or commercial building

A bed-sit:

6 Bed-sit (with some shared facilities e.g. toilet)

A mobile or temporary structure:

7 A caravan or other mobile or temporary structure

H1

START HERE

When was your house, flat orapartment first built?

Mark the year in which first builteven if the building was subsequentlyconverted, extended or renovated.

1 Before 1919

2 1919 - 1945 inclusive

3 1946 - 1960 inclusive

4 1961 - 1970 inclusive

5 1971 - 1980 inclusive

6 1981 - 1990 inclusive

7 1991 - 2000 inclusive

8 2001 - 2005 inclusive

9 2006 or later

H2

Does your household own or rentyour accommodation?

Mark one box only.

1 Own with mortgage or loan

2 Own outright

3 Rent

4 Live here rent free

If renting, who is your landlord?

1 Private landlord

2 Local Authority

3 Voluntary/Co-operative housing body

If your accommodation is rented,how much rent does yourhousehold pay?

Enter amount to the nearest Euro.

€

Mark one box only.

1 Per week

2 Per month

3 Per year

H3

H4

How many rooms do you have foruse only by your household?

Do NOT count bathrooms, toilets, kitchenettes, utility rooms, consulting rooms, offices, shops, halls or landings, or rooms that can only be used for storage such as cupboards.

Do count all other rooms such askitchens, living rooms, bedrooms, conservatories you can sit in, and studies.

If two rooms have been converted intoone, count them as one room.

Number of rooms

H5

What is the main type of fuelused by the central heating inyour accommodation?

Mark one box only.

1 No central heating

2 Oil

3 Natural Gas

4 Electricity

5 Coal (including anthracite)

6 Peat (including turf)

7 Liquid Petroleum Gas (LPG)

8 Wood (including wood pellets)

9 Other

H6

What type of piped water supplydoes your accommodation have?

Mark one box only.

1 Connection to a Public Main

2 Connection to a Group Water Scheme with a Local Authority source of supply

3 Connection to a Group Water Scheme with a private source of supply (e.g. borehole, lake, etc.)

4 Connection to other private source (e.g. well, lake, rainwater tank, etc.)

5 No piped water supply

H7

What type of sewerage facilitydoes your accommodation have?

Mark one box only.

1 Public sewerage scheme

2 Individual septic tank

3 Individual treatment system other than a septic tank

4 Other sewerage facility

5 No sewerage facility

H8

How many cars or vans are owned or are available for use by one or more members of your household?

Include any company car or van ifavailable for private use.

Mark one box only.

1 One

2 Two

3 Three

4 Four or more

5 None

H9

Does your household have apersonal computer (PC)?

1 Yes

2 No

H10

Does your household have accessto the Internet?

Mark ‘Yes’ if you have accessto the Internet in your home.

1 Yes, Broadband connection

2 Yes, other connection

3 No

H11

H12 Go to next page

•

•

•

Questions about your accommodation

0 0•

Household Form

EH02

ALL PERSONS MUST BE ENUMERATED WHERE THEY SPEND CENSUS NIGHT

Below are two lists. List 1 is for persons present at this address on the night of Sunday 10 April, Census Night.List 2 is for persons who usually live at this address but who are temporarily away on the night of Sunday 10 April.See the Explanatory Notes relating to Question 7 on the back page for guidance in interpreting a person’s place of usual residence.

PRESENT PERSONS

INCLUDE in List 1

• All persons alive at midnight on Sunday 10 April who spent the night at this address.

• Persons who stayed temporarily in the household (i.e. visitors).

• Persons who arrived the following morning not having been enumerated elsewhere.

DO NOT INCLUDE in List 1

• Any person who usually lives at this address but who is temporarily absent on the night of Sunday 10 April. These persons should be listed as being absent in List 2 below.

• Students who were away from home on the night of Sunday 10 April. They should be listed as being absent in List 2 below.

• Babies born after midnight on Sunday 10 April.

Household FormPage 3 Household Form

LIST 1 Persons PRESENT in the household on the night of Sunday 10 April

1

2

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12

LIST 2 Absent persons who usually live in the household

Person No. First name and surname

1

2

3

4 If there are more than 4 usual residents absent on the night of Sunday 10 April, please ask yourEnumerator for guidance.

ABSENT PERSONS

INCLUDE in List 2

• All persons who usually live at this address but who are temporarily absent on Sunday 10 April.

• Students away at school or college.

DO NOT INCLUDE in List 2

• Anyone included in List 1.

Page 3 Household FormPage 3 Household Form

Answer questions beginning on Page 22 for each usual resident listed here as being absent from the household on the night of Sunday 10 April.

Answer questionsrelating to eachperson present in thehousehold on Sunday10 April beginning onPage 4 in the sameorder as listed here.

Answer questionsrelating to persons7, 8, 9 etc. onadditional blue IndividualForms available fromyour Enumerator.

Person No. First name and surname

Household Form Page 3

EH03

Person 1 See Explanatory Notes on back page Mark boxes like this

1 What is your name? (Person 1)First name and surname.

2 Sex

1 Male 2 Female

3 What is your date of birth? Day Month Year

Relationship question does not apply to Person 1.

What is your current marital status? Answer if aged 15 years or over.

Mark one box only.

1 Single (never married)

2 Married (first marriage)

3 Re-married (following widowhood)

4 Re-married (following divorce/annulment)

5 Separated (including deserted)

6 Divorced

7 Widowed

4

5

7 Where do you usually live?

1 HERE at this address

2 Elsewhere in IRELAND (including Northern Ireland), write in your FULL ADDRESS

3 Elsewhere ABROAD, write in the COUNTRY

8 Where did you usually live oneyear ago?Answer if aged 1 year or over.

1 SAME as now

2 Elsewhere in IRELAND (including Northern Ireland), write in the COUNTY


9 Have you lived outside the Republicof Ireland for a continuous periodof one year or more?Answer if aged 1 year or over andliving in Ireland.

1 Yes

2 No

If ‘Yes’, write in the YEAR of last takingup residence in the Republic of Ireland

AND

the COUNTRY of last previous residence.

10 What is your nationality?If you have more than one nationality,please declare all of them.

1 Irish

2 Other NATIONALITY, write in

3 No nationality

11 What is your ethnic or culturalbackground?Choose ONE section from A to D,then the appropriate box.

A White

1 Irish

2 Irish Traveller

3 Any other White background

B Black or Black Irish

4 African

5 Any other Black background

C Asian or Asian Irish

6 Chinese

7 Any other Asian background

D Other, including mixed background

8 Other, write in description

13 How many children have yougiven birth to?This question is for women only.

Write in number of children born alive.

1 None

12 What is your religion?Mark one box only.

1 Roman Catholic

2 Church of Ireland

3 Islam

4 Presbyterian

5 Orthodox

6 Other, write in your RELIGION

7 No religion

14 Can you speak Irish?Answer if aged 3 years or over.

1 Yes

2 No

If ‘Yes’, do you speak Irish?Mark the boxes that apply.

1 Daily, within the education system

2 Daily, outside the education system

3 Weekly

4 Less often

5 Never

Household Form

What is your place of birth? Give the place where your mother lived at the time of your birth.

If IRELAND (including Northern Ireland), write in the COUNTY.

If elsewhere ABROAD, write in the COUNTRY.

6

EH04

Person 1 Write in BLOCK CAPITALS Mark boxes like this

Do you speak a language other thanEnglish or Irish at home?

1 Yes

2 No

What is this language?

(e.g. POLISH, GERMAN, IRISH SIGN LANGUAGE)

How well do you speak English?

Mark one box only.

1 Very well

2 Well

3 Not well

4 Not at all

Go to Q16

Do you have any of the following long-lasting conditions or difficulties?

(a) Blindness or a serious Yes No vision impairment

(b) Deafness or a serious Yes No hearing impairment

(c) A difficulty with basic physical Yes No activities such as walking, climbing stairs, reaching, lifting or carrying

(d) An intellectual disability Yes No

(e) A difficulty with learning, Yes No remembering or concentrating

(f) A psychological or Yes No emotional condition

(g) A difficulty with pain, Yes No breathing, or any other chronic illness or condition

If ‘Yes’ to any of the categories specified in Question 16, do you have any difficulty in doing any of the following?

(a) Dressing, bathing or getting Yes No around inside the home

(b) Going outside the home Yes No alone to shop or visit a doctor’s surgery

(c) Working at a job or business Yes No or attending school or college

(d) Participating in other Yes No activities, for example leisure or using transport

How is your healthin general?

Mark one box only.

1 Very good

2 Good

3 Fair

4 Bad

5 Very bad

How do you usuallytravel to work, schoolor college?

Mark one box only,for the longest part, bydistance, of your usualjourney to work, schoolor college.

Not at work, school or college

On foot

Bicycle

Bus, minibus or coach

Train, DART or LUAS

Motor cycle or scooter

Driving a car

Passenger in a car

Van

Other, including lorry

Work mainly at or from home

What time do you usuallyleave home to go to work,school or college?

1 Not at work, school or college

2 Before 06.30

3 06.30 - 07.00

4 07.01 - 07.30

5 07.31 - 08.00

6 08.01 - 08.30

7 08.31 - 09.00

8 09.01 - 09.30

9 After 09.30

How long does yourjourney to work, schoolor college usually take?

Write in minutes.

Do you provide regular unpaidpersonal help for a friend or familymember with a long-term illness,health problem or disability?Include problems which are due to old age.Personal help includes help with basic tasks such as feeding or dressing. 1 Yes

2 No

If ‘Yes’, for how many hours per week?Write in hours.

What is the highest level of education/training (full-time or part-time) which you have completed to date?

Mark one box only.

No formal education/training

Primary education NFQ Levels 1 or 2 FETAC Level 1 or 2 Cert. or equivalent

Lower Secondary NFQ Level 3 Junior/Inter/Group Cert., FETAC Level 3 Cert., FÁS Introductory Skills, NCVA Foundation Cert. or equivalent

Upper Secondary NFQ Levels 4 or 5 Leaving Cert. (including Applied and Vocational programmes) or equivalent

Technical or Vocational NFQ Levels 4 or 5 FETAC Level 4/5 Cert., NCVA Level 1/2, FÁS Specific Skills, Teagasc Cert. in Agriculture, CERT Craft Cert. or equivalent

Advanced Certificate/Completed Apprenticeship NFQ Level 6 FETAC Advanced Cert., NCVA Level 3, FÁS National Craft Cert., Teagasc Farming Cert., CERT Professional Cookery Cert. or equivalent

Higher Certificate NFQ Level 6 NCEA/HETAC National Cert. or equivalent

Ordinary Bachelor Degree or National Diploma NFQ Level 7

Honours Bachelor Degree/ Professional qualification or both NFQ Level 8

Postgraduate Diploma or Degree NFQ Level 9 Postgraduate Diploma, Masters Degree or equivalent

Doctorate (Ph.D) or higher NFQ Level 10

If you are aged under 15

Go to Q34

Have you ceased your full-timeeducation?

1 Yes

2 No

If ‘Yes’, write in AGE at which it ceased.

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Household Form

EH05


What is the main field of study ofthe highest qualification you havecompleted to date?

Exclude Secondary school qualifications.

Write in the field of study.

(e.g. ACCOUNTANCY, BEAUTY THERAPY,FARMING, PLUMBING)

Household Form

26

How would you describe your presentprincipal status?

Mark one box only.

1 Working for payment or profit

2 Looking for first regular job

3 Unemployed

4 Student or pupil

5 Looking after home/family

6 Retired from employment

7 Unable to work due to permanent sickness or disability

8 Other, write in

27

If you are working,unemployed or retired

If you are a student

Otherwise

Go to Q2928

Go to Q34

Go to Q35

Do (did) you work as an employee orare (were) you self-employed in yourmain job?

Your main job is the job in which youusually work(ed) the most hours.

Mark one box only.

1 Employee

2 Self-employed, with paid employees

3 Self-employed, without paid employees

4 Assisting relative (not receiving a fixed wage or salary)

29

What is (was) your occupation in your main job?

In all cases describe the occupation fully and precisely giving the full job title.

Use precise terms such as Do NOT use general terms such as RETAIL STORE MANAGER MANAGER SECONDARY TEACHER TEACHER ELECTRICAL ENGINEER ENGINEER Civil servants and local government employees should state their grade e.g.SENIOR ADMINISTRATIVE OFFICER. Members of the Gardaí or Armyshould state their rank. Teachers should state the branch of teaching e.g.PRIMARY TEACHER. Clergy and religious orders should give full descriptione.g. NUN, REGISTERED GENERAL NURSE.

Write in your main OCCUPATION.

If a farmer, write in the SIZE of the area farmed to the nearest hectare.

Hectares

30

What is (was) the business of your employer at the place where youwork(ed) in your main job?

If you are (were) self-employed answer in respect of your own business.Describe the main product or service provided by your employer. For example, MAKING COMPUTERS, REPAIRING CARS, SECONDARYEDUCATION, FOOD WHOLESALE, MAKING PHARMACEUTICALS,CONTRACT CLEANING, SOFTWARE DEVELOPMENT AND SUPPORT.

32

If you are retired Go to Q3531

If you are unemployed Go to Q3533

What is the FULL NAME and ADDRESS of your place of work,school or college?

34

Full name

Address

1 Work mainly at or from home 2 No fixed place of work

Answer questions for Person 2 starting on the next page.If there is only one person present in the householdon the night of 10 April Go to page 22

35

EH06



2 Sex

1 Male 2 Female

What is your relationship to Person 1?

Mark one box only.

Relationship of Person PERSON 2 to 1

Husband or wife 1

Partner 2 (incl. same-sex partner)

Son or daughter 3

Step-child 4

Brother or sister 5

Mother or father 6

Grandparent 7

Step-mother/-father 8

Son-/daughter-in-law 9

Grandchild 10

Other related 11

Unrelated 12 (incl. foster child)


Mark one box only.






6 Divorced

7 Widowed

4

5




6






1 SAME as now




1 Yes

2 No


AND



1 Irish


3 No nationality


A White

1 Irish

2 Irish Traveller



4 African



6 Chinese






1 None


1 Roman Catholic

2 Church of Ireland

3 Islam

4 Presbyterian

5 Orthodox


7 No religion


1 Yes

2 No




3 Weekly

4 Less often

5 Never


Household Form

EH07



1 Yes

2 No




Mark one box only.

1 Very well

2 Well

3 Not well

4 Not at all

Household Form

Go to Q16















Mark one box only.

1 Very good

2 Good

3 Fair

4 Bad

5 Very bad




On foot

Bicycle


Train, DART or LUAS


Driving a car

Passenger in a car

Van





2 Before 06.30

3 06.30 - 07.00

4 07.01 - 07.30

5 07.31 - 08.00

6 08.01 - 08.30

7 08.31 - 09.00

8 09.01 - 09.30

9 After 09.30


Write in minutes.


2 No



Mark one box only.













Go to Q34


1 Yes

2 No


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EH08






26


Mark one box only.



3 Unemployed

4 Student or pupil




8 Other, write in

27



Otherwise

Go to Q2928

Go to Q34

Go to Q35



Mark one box only.

1 Employee




29






Hectares

30



32




34

Full name

Address


Answer questions for Person 3 starting on the next page.If there are only two persons present in the householdon the night of 10 April Go to page 22

35

Household Form

EH09



2 Sex

1 Male 2 Female

What is your relationship to Persons 1 and 2?

Mark one box only for each person.

Relationship of Persons PERSON 3 to 1 2

Husband or wife 1


Son or daughter 3

Step-child 4

Brother or sister 5

Mother or father 6

Grandparent 7



Grandchild 10

Other related 11



Mark one box only.






6 Divorced

7 Widowed

4

5






1 SAME as now




1 Yes

2 No


AND



1 Irish


3 No nationality


A White

1 Irish

2 Irish Traveller



4 African



6 Chinese






1 None


1 Roman Catholic

2 Church of Ireland

3 Islam

4 Presbyterian

5 Orthodox


7 No religion


1 Yes

2 No




3 Weekly

4 Less often

5 Never

Household Form





6

EH10



1 Yes

2 No




Mark one box only.

1 Very well

2 Well

3 Not well

4 Not at all

Go to Q16















Mark one box only.

1 Very good

2 Good

3 Fair

4 Bad

5 Very bad




On foot

Bicycle


Train, DART or LUAS


Driving a car

Passenger in a car

Van





2 Before 06.30

3 06.30 - 07.00

4 07.01 - 07.30

5 07.31 - 08.00

6 08.01 - 08.30

7 08.31 - 09.00

8 09.01 - 09.30

9 After 09.30


Write in minutes.


2 No



Mark one box only.













Go to Q34


1 Yes

2 No


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Household Form

EH11






Household Form

26


Mark one box only.



3 Unemployed

4 Student or pupil




8 Other, write in

27



Otherwise

Go to Q2928

Go to Q34

Go to Q35



Mark one box only.

1 Employee




29






Hectares

30



32




34

Full name

Address


Answer questions for Person 4 starting on the next page.If there are only three persons present in the householdon the night of 10 April Go to page 22

35

EH12



2 Sex

1 Male 2 Female


Mark one box only.






6 Divorced

7 Widowed

4

5






1 SAME as now




1 Yes

2 No


AND



1 Irish


3 No nationality


A White

1 Irish

2 Irish Traveller



4 African



6 Chinese






1 None


1 Roman Catholic

2 Church of Ireland

3 Islam

4 Presbyterian

5 Orthodox


7 No religion


1 Yes

2 No




3 Weekly

4 Less often

5 Never

What is your relationship to Persons 1, 2 and 3?


Relationship of Persons PERSON 4 to 1 2 3

Husband or wife 1


Son or daughter 3

Step-child 4

Brother or sister 5

Mother or father 6

Grandparent 7



Grandchild 10

Other related 11






6

Household Form

EH13



1 Yes

2 No




Mark one box only.

1 Very well

2 Well

3 Not well

4 Not at all

Household Form

Go to Q16















Mark one box only.

1 Very good

2 Good

3 Fair

4 Bad

5 Very bad




On foot

Bicycle


Train, DART or LUAS


Driving a car

Passenger in a car

Van





2 Before 06.30

3 06.30 - 07.00

4 07.01 - 07.30

5 07.31 - 08.00

6 08.01 - 08.30

7 08.31 - 09.00

8 09.01 - 09.30

9 After 09.30


Write in minutes.


2 No



Mark one box only.













Go to Q34


1 Yes

2 No


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EH14






26


Mark one box only.



3 Unemployed

4 Student or pupil




8 Other, write in

27



Otherwise

Go to Q2928

Go to Q34

Go to Q35



Mark one box only.

1 Employee




29






Hectares

30



32




34

Full name

Address


Answer questions for Person 5 starting on the next page.If there are only four persons present in the householdon the night of 10 April Go to page 22

35

Household Form

EH15



2 Sex

1 Male 2 Female

What is your relationship to Persons 1, 2, 3 and 4?


Relationship of PersonsPERSON 5 to 1 2 3 4

Husband or wife 1

Partner 2(incl. same-sex partner)

Son or daughter 3

Step-child 4

Brother or sister 5

Mother or father 6

Grandparent 7



Grandchild 10

Other related 11

Unrelated 12(incl. foster child)


Mark one box only.






6 Divorced

7 Widowed

4

5






1 SAME as now




1 Yes

2 No


AND



1 Irish


3 No nationality


A White

1 Irish

2 Irish Traveller



4 African



6 Chinese






1 None


1 Roman Catholic

2 Church of Ireland

3 Islam

4 Presbyterian

5 Orthodox


7 No religion


1 Yes

2 No




3 Weekly

4 Less often

5 Never

Household Form





6

EH16



1 Yes

2 No




Mark one box only.

1 Very well

2 Well

3 Not well

4 Not at all

Go to Q16















Mark one box only.

1 Very good

2 Good

3 Fair

4 Bad

5 Very bad




On foot

Bicycle


Train, DART or LUAS


Driving a car

Passenger in a car

Van





2 Before 06.30

3 06.30 - 07.00

4 07.01 - 07.30

5 07.31 - 08.00

6 08.01 - 08.30

7 08.31 - 09.00

8 09.01 - 09.30

9 After 09.30


Write in minutes.


2 No



Mark one box only.













Go to Q34


1 Yes

2 No


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Household Form

EH17






Household Form

26


Mark one box only.



3 Unemployed

4 Student or pupil




8 Other, write in

27



Otherwise

Go to Q2928

Go to Q34

Go to Q35



Mark one box only.

1 Employee




29






Hectares

30



32




34

Full name

Address


Answer questions for Person 6 starting on the next page.If there are only five persons present in the householdon the night of 10 April Go to page 22

35

EH18



2 Sex

1 Male 2 Female

What is your relationship to Persons 1, 2, 3 and 4?


Relationship of PersonsPERSON 6 to 1 2 3 4

Husband or wife 1


Son or daughter 3

Step-child 4

Brother or sister 5

Mother or father 6

Grandparent 7



Grandchild 10

Other related 11



Mark one box only.






6 Divorced

7 Widowed

4

5






1 SAME as now




1 Yes

2 No


AND



1 Irish


3 No nationality


A White

1 Irish

2 Irish Traveller



4 African



6 Chinese






1 None


1 Roman Catholic

2 Church of Ireland

3 Islam

4 Presbyterian

5 Orthodox


7 No religion


1 Yes

2 No




3 Weekly

4 Less often

5 Never





6

Household Form

EH19



1 Yes

2 No




Mark one box only.

1 Very well

2 Well

3 Not well

4 Not at all

Household Form

Go to Q16















Mark one box only.

1 Very good

2 Good

3 Fair

4 Bad

5 Very bad




On foot

Bicycle


Train, DART or LUAS


Driving a car

Passenger in a car

Van





2 Before 06.30

3 06.30 - 07.00

4 07.01 - 07.30

5 07.31 - 08.00

6 08.01 - 08.30

7 08.31 - 09.00

8 09.01 - 09.30

9 After 09.30


Write in minutes.


2 No



Mark one box only.













Go to Q34


1 Yes

2 No


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4

5

6

7

8

9

10

11

1

2

3

4

5

6

7

8

9

10

11

EH20






26


Mark one box only.



3 Unemployed

4 Student or pupil




8 Other, write in

27



Otherwise

Go to Q2928

Go to Q34

Go to Q35



Mark one box only.

1 Employee




29






Hectares

30



32




34

Full name

Address


If there are more than 6 persons present in the household on the night of Sunday 10 April, you will need an Individual Form for each additional person. Please ask your Enumerator for additional forms.Otherwise Go to the next page

35

Household Form

EH21

Household Form

Absent Persons who usually live in the household

A1 What is this person’s name?First name and surname.

A4 What is the relationship of thisperson to Person 1 on page 4?

Mark one box only.

Husband or wife

Partner (including same-sex partner)

Son or daughter

Other related, write in RELATIONSHIP

Unrelated (including foster child)

Answer questions A1 to A8 for all household members who usually live here at this address but who are NOT present onthe night of Sunday 10 April. Include in particular all primary, secondary and third level students who are living away from home during term time who are NOT present at this address on the night of Sunday 10 April.

Absent Person 1

A2 Sex

1 Male 2 Female

A3 What is this person’s date of birth? Day Month Year

A5 What is this person’s currentmarital status?

Answer if aged 15 years or over.Mark one box only.


2 Married (including re-married)


6 Divorced

7 Widowed

A6 How long altogether is thisperson away for?

1 Less than 12 months

2 12 months or more

A7 Was this person in the Republicof Ireland on Sunday 10 April?

1 Yes

2 No

A8 Is this person a student away at school or college?

1 Yes

2 No



Mark one box only.

Husband or wife


Son or daughter



Absent Person 2

A2 Sex

1 Male 2 Female







6 Divorced

7 Widowed



2 12 months or more


1 Yes

2 No


1 Yes

2 No



Mark one box only.

Husband or wife


Son or daughter



Absent Person 3

A2 Sex

1 Male 2 Female







6 Divorced

7 Widowed



2 12 months or more


1 Yes

2 No


1 Yes

2 No

1

2

3

11

12

1

2

3

11

12

1

2

3

11

12

EH22

Absent Person 4 Declaration



Mark one box only.

Husband or wife


Son or daughter



A2 Sex

1 Male 2 Female







6 Divorced

7 Widowed



2 12 months or more


1 Yes

2 No


1 Yes

2 No

Before you sign the declaration please check:

• That you have completed the questions about your accommodation on page 2.

• That in List 1 on page 3, you have accounted for all persons (including visitors) who spent the night of Sunday 10 April at this address.

• That you have answered all questions which should have been answered for each person who spent the night of Sunday 10 April in the household (pages 4-21).

• That in List 2 on page 3, you have accounted for all persons who usually live at this address but who were temporarily absent on Sunday 10 April.

• That you have answered all questions on pages 22-23 for all household members temporarily absent on the night of Sunday 10 April.

• That no person has been double-counted on the form.

If there are more than 4 personstemporarily absent from the householdon the night of Sunday 10 April, pleaseask your Enumerator for guidance.

Declaration to be completed by the person responsible for completing the form.

I declare that this form is correct and complete to the best of my knowledge and belief.

Signature

You have now completed the Census Form.

Thank you for your co-operation.

1

2

3

11

12

Household Form

EH23

Explanatory Notes

Question H3 – Does your household own or rent your accommodation?If you rent your accommodation (box 3), or live in it rent free (box 4), you should also answer the second part of the question ‘who is your landlord?’. Select the appropriate box (1, 2 or 3) to indicate whether your landlord is a ‘Private landlord’, a ‘Local Authority’ or a ‘Voluntary/Co-operative housing body’, regardless of whether or not you pay all or part of the rent yourself, or if it is paid on your behalf by the HSE or any other body.

Question H4 – If your accommodation is rented, how much rent does your household pay?If the HSE or any other body pays part of the rent, only the amount paid by the household should be entered. Enter the amount to the nearest Euro and mark the box corresponding to the period covered e.g. if your household pays a weekly rent of €78.60 enter 79 and mark box 1. If all of your rent is paid on your behalf enter 0 and mark box 1.

Question 4 – RelationshipThe relationship question is designed to determine families within households. This includes where there are two or more families in the one household. For example, a household consisting of an adult daughter living with her two parents and her own child would be counted as a two family household.

The example given below shows how the question should be answered for the child in this situation, where the parents are Persons 1 and 2 on the form, the adult daughter is Person 3 and the child is Person 4.


Relationship of PersonsPERSON 4 to 1 2 3

Husband or wife 1


Son or daughter 3

Step-child 4

Brother or sister 5

Mother or father 6

Grandparent 7



Grandchild 10

Other related 11


Question 7 – Where do you usually live?This question refers to your place of usual residence at the time of the Census. If you have lived at this address for a continuousperiod of at least 12 months before Census Night, or have arrived at this address in the 12 month period before Census Night with the intention of staying here for at least one year you should mark box 1 (HERE). If your usual residence is not here but is elsewhere in Ireland (including Northern Ireland) you should mark box 2 and write in your full address. If your usual residence is elsewhere abroad you should mark box 3 and give the country of usual residence.

The general guideline is that a person’s place of usual residence is where he/she spends most of his/her daily night rest. The following specific guidelines should be used:

• Those away from home during the week who return to the family home at weekends should consider the family home as their place of usual residence.

• Primary and secondary students who are boarding away from home, and third level students at college or university, should consider the family home as their place of usual residence.

• If a person has spent or intends to spend 12 months or more in an institution then the institution is that person’s place of usual residence.

• If a person regularly lives in more than one residence during the year then the place where he/she spends the majority of the year should be chosen as his/her place of usual residence.

Question 8 – Where did you usuallylive one year ago?This question is for persons aged 1 year or over. The guidelines in relation to Question 7 also apply to this question. If your place of usual residence one year before the Census was the same as now you should mark box 1 (SAME as now).

Question 9 – Have you lived outside the Republic of Ireland for a continuous period of one year or more?This question is for persons aged 1 year or over. If your place of usual residence is in the Republic of Ireland and you were either:

• born in this country and lived outside it for a continuous period of one year or more, or

• born abroad and lived outside Ireland for a continuous period of one year or more,

then you should mark box 1 (Yes). You should also write in the year of last takingup residence in this country and thecountry of last previous residence.

Question 15 – Do you speak a language other than English or Irish at home?If you do not speak a language other thanEnglish or Irish at home you should markbox 2 (No) and proceed to Question 16. This means those who speak only English and/or Irish at home do not have to reporton their ability to speak the English language.

Question 16 – Do you have any of the following long-lasting conditions or difficulties?For the purpose of this question a long lasting condition or difficulty is one which has lasted or is expected to last 6 months or longer, or that regularly re-occurs.

Question 22 – Do you provide regularunpaid personal help for a friend orfamily member with a long-term illness, health problem or disability?If you provide regular unpaid help as a carer, regardless of whether or not you are in receipt of Carer’s Allowance/Benefit, you should mark box 1 (Yes) and write in the weekly number of hours of caring.

Question 25 – What is the highest level of education/training (full-time or part-time) which you have completed to date?The categories distinguished in this question follow the National Framework of Qualifications (NFQ). Further details can be found at www.nfq.ie

Further information on FETAC, HETAC, foreign qualifications and all otherqualifications in general can be found at www.census.ie

Question 26 – What is the main field of study of the highest qualification you have completed to date?This question is to capture post-secondaryschool qualifications only. If you have a number of qualifications, the field of study relating to the highest qualification only should be listed.

Question 27 – How would you describeyour present principal status?You should mark one box only to select the category which you feel best describes your present principal status. If you are on sick leave or maternity leave and intend to return to work at some stage you should mark box 1 (Working).

Question 34 – Address of place ofwork, school or collegePersons who leave the household to attend work, school or college should supply the full name and address of this place.

For children who attend pre-school facilities (e.g. crèche, kindergarten) outside the home, the full name and address of this facility should be supplied by the person filling in the form.

Household Form

EH24

D’úsáid oifige amháinSeoladh

Cód Contae

Cód Limistéir Áirimh

Cód Ceantair Bhig Uimhir D. Fireannaigh Baineannaigh Iomlán

Daoine AS LÁTHAIR

Líon daoine I LÁTHAIR

Daonáireamh 2011

Beidh Daonáireamh 2011 ann ar an Domhnach 10 Aibreánagus déanfar gach duine agus gach teaghlach sa tír ar an oíche sin a chomhaireamh. Is é seo an ceathrú daonáireamh fichead ón mbliain 1841. Tabharfaidh torthaí an daonáirimh léargas cuimsitheach ar chuinsí sóisialta agus maireachtála ár ndaoine agus tabharfaidh siad cúnamh le pleanáil don todhchaí.

Cad atá le déanamh agat

Coinnigh an fhoirm seo in áit sábháilte le do thoil agus déaní a chomhlánú oíche Dé Domhnaigh 10 Aibreán, Oíche anDaonáirimh. Ba cheart duit breathnú ar na Nótaí Mínithe ar anleathanach cúil le cúnamh a thabhairt duit an fhoirm a chomhlánú.Cuimhnigh an dearbhú ar leathanach 23 a shíniú agus do fhoirm chomhlánaithe a bheith réidh agat le bailiú ag d’Áiritheoir.

Rannpháirteachas éigeantach faoin dlí

Seo Fógra faoi Alt 26 den Acht Staidrimh 1993. Tá an Daonáireamhá dhéanamh faoin Acht Staidrimh 1993 agus faoin Ordú Staidrimh(Daonáireamh) 2010. Faoi Altanna 26 agus 27 den Acht Staidrimh 1993 ní mór duit de réir dlí an fhoirm seo a chomhlánú agus a chur ar ais. Féadfar fíneáil suas le €25,000 a ghearradh ar aon duine a dteipeann air/uirthi, nó a dhiúltaíonn, an t-eolas seo a sholáthar nó a sholáthraíonn eolas bréagach go feasach.

Ráthaítear rúndacht

Tá rúndacht do thuairisceáin daonáirimh ráthaithe ó thaobh dlíag an Acht Staidrimh 1993. Bainfidh an Phríomh-Oifig Staidrimh úsáid as an eolas a sholáthraíonn tú ar chúiseanna staidrimh amháin. San áireamh tá soláthar táblaí staidrimh agus tuairiscí anailíse agus roghnú samplaí do chuid d’ár suirbhéanna.

D’Áiritheoir Daonáirimh

Cabhróidh d’Áiritheoir Daonáirimh leat má bhíonn aoncheisteanna agat faoin Daonáireamh. Iarrtar ort, le do thoil,comhoibriú le d’Áiritheoir le go n-éireoidh le Daonáireamh 2011.

Go raibh maith agat as do chomhoibriú.

Gearóid Ó’hAnluainAn tArd-Stiúrthóir

You can complete the English or Irish version of this form.

Cé a chomhlánóidh an Fhoirm Dhaonáirimh?

Ba chóir go ndéanfadh an ceann teaghlaigh nó aon bhall aosach den teaghlach atá i láthair oíche Dé Domhnaigh 10Aibreán an fhoirm seo a chomhlánú. Ba chóir do gach teaghlach Foirm Theaghlaigh ar leith a chomhlánú.

Is éard atá i dteaghlach ná:• duine amháin atá ina c(h)ónaí leis/léi féin, nó• grúpa daoine gaolta/neamhghaolta atá ina gcónaí ag an

seoladh céanna le comhshocruithe tís, is é sin, ag com-hroinnt béile amháin ar a laghad sa lá nó ag comhroinnt seomra teaghlaigh nó seomra suí.

An dteastaíonn foirmeacha breise uait?

Má tá níos mó ná teaghlach amháin ag an seoladh seo,iarr Foirm Theaghlaigh eile ar d’Áiritheoir.

Má tá níos mó ná seisear i do theaghlach oíche DéDomhnaigh 10 Aibreán, iarr ar d’Áiritheoir Foirm ghormPhearsan Aonair a chur ar fáil do gach duine breise.

Conas an Fhoirm Dhaonáirimh a chomhlánú

1. Úsáid peann Dubh nó Gorm.2. Marcáil boscaí mar seo .3. Má dhéanann tú earráid, déan é seo agus marcáil an bosca cuí.

Nuair a iarrtar ort freagra a scríobh isteach úsáidBLOCLITREACHA le do thoil agus fág spás amháin idir gachfocal. Lean ar aghaidh chuig líne nua mura rachaidh focal ar líne amháin, mar shampla:

Bíodh an fhoirm ullamh le bailiú

Tiocfaidh d’Áiritheoir ar ais idir Dé Luain 11 Aibreán agus DéLuain 9 Bealtaine leis an bhfoirm chomhlánaithe a bhailiú.

Má tharlaíonn sé nach bhfuil an fhoirm agatsa bailithe faoin 9 Bealtaine, cuir ar ais í comhlánaithe ina hiomlán chuig An bPríomh-OifigStaidrimh, Bosca Poist 2011, Saorphost 4726, Sord, Co. Átha Cliath.

F Á I L T E O I

Ó S T Á I N

Foirm Theaghlaigh Leathanach 1

R

GH01

Central Statistics Office

Daonáireamh na hÉireannCensus of Population of Ireland

Dé Domhnaigh 10 Aibreán 2011

Cén cineál cóiríochta ina gcónaíonn do theaghlach?

Marcáil in aon bhosca amháin.

Teach iomlán nó bungaló atá:

1 Scoite

2 Leath-scoite

3 Neamhscoite (lena n-áirítear cinn sraithe tithe neamhscoite)

Árasán (dúbailte san áireamh)glanscartha:

4 I mbloc saindéanta árasán

5 Mar chuid de theach athchóirithe nó foirgneamh tráchtála

Seomra suí/leapa:

6 Seomra suí/leapa (le chuid de na háiseanna roinnte, mar shampla leithreas)

Struchtúr soghluaiste nó sealadach:

7 Carbhán nó struchtúr soghluaiste nó sealadach eile

H1

TOSNAIGH ANSEO

Cén uair ar céad tógadh do theach nó árasán?

Marcáil don bhliain inár céadtógadh é fiú má tá athrú, fairsingiú nó athchóiriú déanta ar an bhfoirgneamh ó shoin.

1 Roimh 1919

2 1919 - 1945 araon san áireamh







9 2006 nó ina dhiaidh

H2

Leathanach 2

An bhfuil do theaghlach mar úinéir ar an gcóiríocht nó an bhfuil sé ar cíos?


1 Úinéir le morgáiste nó iasacht

2 Úinéir ina iomlán

3 Ar cíos

4 I seilbh saor ó chíos

Má tá do chóiríocht ar cíos, cé hé/hí an tiarna talún?

1 Tiarna talún príobháideach

2 An tÚdarás Áitiúil

3 Eagraíocht deonach/ Comharchumann tithíochta

Má tá do chóiríocht ar cíos, cé mhéad cíosa a íocann do theaghlach?

Cuir isteach méad chuig an Euro is gaire.

€


1 Sa tseachtain

2 Sa mhí

3 Sa bhliain

H3

H4

Cé mhéad seomra atá agat lehúsáid ag do theaghlach amháin?

NÁ comhair seomraí folctha, leithris,cistinéid, seomraí acraí, seomraícomhairle, oifigí, siopaí, hallaí ná léibhinn,ná seomraí nach féidir a úsáid achamháin le haghaidh stórála ar nós cupard.

Comhair gach seomra eile, mar shampla cistiní, seomraí teaghlaigh, seomraí codlata, grianáin a suítear iontu agus seomraí staidéir.

Má tá dhá sheomra iompaithe i seomra amháin comhair mar sheomra amháin iad.

Líon seomraí

H5

Céard é an príomhchineál breosla a úsáideann an téamh lárnach i do chóiríocht?


1 Gan aon téamh lárnach

2 Ola

3 Gás Nádúrtha

4 Leictreachas

5 Gual (Antraicít san áireamh)

6 Móin

7 Gás Leachtach Peitriliam (GLP)

8 Adhmad (millíní adhmaid san áireamh)

9 Eile

H6

Cén cineál soláthair uiscephíobaithe atá sa chóiríocht agat?


1 Nasc le Príomhlíonra Poiblí

2 Nasc le Grúp-Scéim Uisce le foinse soláthair Údaráis Áitiúil

3 Nasc le Grúp-Scéim Uisce le foinse phríobháideach soláthair (e.g. poll tóraíochta, loch, srl.)

4 Nasc le foinse phríobháideach eile (e.g. tobar, loch, umar báistí, srl.)

5 Gan aon soláthair uisce phíobaithe

H7

Cén cineál saoráide séarchais atása chóiríocht?


1 Scéim séarachais phoiblí

2 Umar seipteach indibhidiúil

3 Coras indibhidiúil cóireála eile seachas umar seipteach

4 Saoráid séarachais eile

5 Gan aon saoráid séarachais

H8

Cé mhéad gluaisteán nó veain atá ar úinéireacht nó ar fáil le húsáid ag ball amháin nó níos mó den teaghlach?

Áirigh aon ghluaisteán nó veain cuideachta má tá sé ar fáil le haghaidh úsáide príobháidí.


1 Ceann amháin

2 Dhá cheann

3 Trí chinn

4 Ceithre cinn nó níos mó

5 Níl aon cheann

H9

An bhfuil ríomhaire pearsanta(RP) sa teaghlach?

1 Tá

2 Níl

H10

An bhfuil rochtain ag do theaghlach ar an Idirlíon?

Marcáil ‘Tá’ má tá rochtain ar an idirlíon sa bhaile.

1 Tá, le ceangal banda leathan

2 Tá, le ceangal eile

3 Níl

H11

H12 Téigh chuig an gcéad leathanach eile

•

•

•

Ceisteanna maidir le do chóiríocht

0 0•

Foirm Theaghlaigh

GH02

NÍ MÓR GACH DUINE A ÁIREAMH SAN ÁIT A CHAITHEANN SIAD OÍCHE AN DAONÁIRIMH

Tá dhá liosta thíos. Baineann Liosta 1 le daoine a bhí i láthair ag an seoladh seo oíche Dé Domhnaigh 10 Aibreán, Oíche an Daonáirimh. Baineann Liosta 2 le daoine a bhfuil gnáthchónaí ag an seoladh seo orthu ach atá as láthair go sealadach oíche Dé Domhnaigh 10 Aibreán. Féach na Nótaí Mínithe a bhaineann le Ceist 7 ar an leathanach cúil le treoir a fháil maidir le gnátháit chónaithe an duine a dhéanamh amach.

DAOINE I LÁTHAIR

ÁIRIGH i Liosta 1

• Gach duine beo ag meánoíche oíche Dé Domhnaigh 10 Aibreán a chaitheann an oíche ag an seoladh seo.

• Daoine a d’fhan go sealadach sa teaghlach (mar shampla cuairteoirí).

• Daoine a tháinig go dtí an teaghlach an mhaidin ina dhiaidh agus nár áiríodh aon áit eile.

NÁ hÁIRIGH i Liosta 1

• Aon duine a bhfuil gnáthchónaí ag an seoladh seo air ach atá as láthair go sealadach oíche Dé Domhnaigh 10 Aibreán. Ba cheart na daoine seo a liostáil mar as láthair i Liosta 2 thíos.

• Mic léinn atá as láthair ón baile oíche Dé Domhnaigh 10 Aibreán. Ba cheart iad a liostáil mar as láthair i Liosta 2 thíos.

• Babaithe a saolaíodh i ndiaidh mheán oíche Dé Domhnaigh 10 Aibreán.


LIOSTA 1 Daoine I LÁTHAIR sa teaghlach oíche Dé Domhnaigh 10 Aibreán

1

2

3

4

5

6

7

8

9

10

11

12

LIOSTA 2 Daoine as láthair a bhfuil gnáthchónaí orthu sa teaghlach

Céad ainm agus sloinne

1

2

3

4 Má tá níos mó ná 4 gnáthchónaitheoir as láthair oíche Dé Domhnaigh 10 Aibreán, iarr comhairle ar d’Áiritheoir le do thoil.

DAOINE AS LÁTHAIR

ÁIRIGH i Liosta 2

• Gach duine a bhfuil gnáthchónaí air/uirthi ag an seoladh seo ach a bhí as láthair go sealadach Dé Domhnaigh 10 Aibreán.

• Mic léinn as láthair ar scoil nó coláiste.

NÁ hÁIRIGH i Liosta 2

• Aon duine áirithe i Liosta 1.


Freagair ceisteanna agtosú ar Leathanach 22do gach gnáthchónaitheoir atá liostaithe anseo maras láthair oíche Dé Domhnaigh 10 Aibreán.

Freagair ceisteanna maidir le gach duine i láthair sa teaghlach oíche Dé Domhnaigh 10 Aibreán ag tosú ar Leathanach 4 san ord céanna mar a liostaítear anseo.

Freagair ceisteanna maidir le daoine 7, 8, 9srl. ar Fhoirmeacha breise gorma Pearsana Aonair atá ar fáil ó d’Áiritheoir.

Céad ainm agus sloinneUimhir an Duine

Uimhir an Duine


GH03

Duine 1 Féach nótaí mínithe ar leathanach cúil Marcáil boscaí mar seo

1 Cad is ainm duit? (Duine 1)Céad ainm agus sloinne.

2 Gnéas

1 Fireann 2 Baineann

Cad é do stádas pósta reatha? Freagair má tá tú 15 bliana d’aois nó níos sine.


1 Aonta (níor phós riamh)

2 Pósta (an chéad phósadh)

3 Athphósta (i ndiaidh baintreachais)

4 Athphósta (i ndiaidh colscartha/neamhnithe)

5 Idirscartha (lena n-áirítear tréigthe)

6 Colscartha

7 Baintreach

4

5

Cad í d’áit bhreithe? Tabhair áit chónaithe do mháthar nuair a saolaíodh thú.

Más ÉIRE (Tuaisceart Éireann san áireamh), an freagra, sonraigh an CONTAE.

Más áit eile THAR LEAR é, sonraigh an TÍR.

6

7 Cá bhfuil gnáthchónaí ort?

1 ANSEO ag an seoladh seo

2 Áit eile in ÉIRINN (Tuaisceart Éireann san áireamh), sonraigh do SHEOLADH IOMLÁN

3 Áit eile THAR LEAR, sonraigh an TÍR

8 Cá raibh gnáthchónaí ort bliain ó shin? Freagair má tá tú bliain amháin d’aois nóníos sine.

1 Seoladh CÉANNA

2 Áit eile in ÉIRINN (Tuaisceart Éireann san áireamh), sonraigh an CONTAE


9 An raibh cónaí ort taobh amuigh de Phoblacht na hÉireann ar feadh tréimhse leanúnaí de bhliain nó níos mó?Freagair má tú bliain amháin d’aois nó níos sine agus cónaí in Éirinn ort.

1 Bhí 2 Ní raibh

Má ‘Bhí’ scríobh isteach an BHLIAIN artháinig tú chun cónaithe i bPoblacht na hÉireann don uair dheireanach

AGUS

an TÍR dheireanach a raibh cónaí ort inti.

10 Cén náisiúntacht atá agat?Má tá níos mó ná náisiúntacht amháinagat, luaigh gach ceann díobh.

1 Éireannach

2 NÁISIÚNTACHT eile, sonraigh

3 Gan aon náisiúntacht

11 Cén grúpa eitneach nó cultúr lenambaineann tú?Roghnaigh rannóg AMHÁIN ó A go D,cuir sa bhosca cuí ansin.

A Cine Geal

1 Éireannach

2 Ball de Lucht Taistil na hÉireann

3 Aon chúlra Geal eile

B Cine Gorm nó Éireannach Gorm

4 Afraiceach

5 Aon chúlra Gorm eile

C Áiseach nó Áiseach Éireannach

6 Síneach

7 Aon chúlra Áiseach eile

D Eile, cúlra measctha san áireamh

8 Eile, sonraigh

13 Cé mhéad leanaí a saolaíodh duit?Do mhná amháin an cheist seo.

Scríobh isteach an méad leanaí asaolaíodh beo.

1 Duine ar bith

12 Cén creideamh atá agat?Marcáil in aon bhosca amháin.

1 Caitliceach

2 Eaglais na hÉireann

3 Ioslamachas

4 Preispitéireach

5 Ceartchreidmheach

6 Eile, sonraigh do CHREIDEAMH

7 Níl aon chreideamh

14 An bhfuil Gaeilge labhartha agat?Freagair má tá tú 3 bliana d’aois nó níos sine.

1 Tá

2 Níl

Má ‘Tá’, an labhraíonn tú Gaeilge?Marcáil i ngach bosca cuí.

1 Go laethúil, sa chóras oideachais

2 Go laethúil, taobh amuigh den chóras oideachais

3 Go seachtainiúil

4 Ní chomh minic sin

5 Ní labhraíonn riamh í

3 Cad é do dháta breithe? Lá Mí Bliain

Foirm TheaghlaighLeathanach 4

Ní bhaineann ceist an ghaoil le Duine 1.

GH04

Duine 1 Scríobh i mBLOCLITREACHA Marcáil boscaí mar seo

An labhraíonn tú teanga seachas Béarla nó Gaeilge sa bhaile?

1 Labhraíonn

2 Ní Labhraíonn

Cén teanga í sin?

(e.g. POLAINNIS, GEARMÁINIS, TEANGA CHOMHARTHAÍOCHTA NA hÉIREANN)

Cén cumas labhartha an Bhéarla atá agat?


1 An-mhaith

2 Go maith

3 Go dona

4 Ní labhraíonn

Leathanach 5

Téigh ar aghaidh chuig C16

An bhfuil aon cheann de na riochtaí fadtéarmacha seo a leanas ort?

(a) Daille nó mórlagú amhairc Tá Níl

(b) Bodhaire nó mórlagú Tá Níl éisteachta

(c) Riocht a bhacann go mór Tá Níl bunghníomhaíochtaí fisiceacha mar shiúl, dul suas staighre, síneadh, ardú nó iompar

(d) Míchumas intleachtúil Tá Níl

(e) Deacracht le foghlaim, Tá Níl cuimhneamh nó comhdhíriú

(f) Riocht síceolaíoch nó Tá Níl tochtach

(g) Deacracht le pian, analú, Tá Níl nó aon droch thinneas nó riocht eile

Má d’fhreagair tú ‘Tá’ i dtaobh aon riocht i gCeist 16, an mbíonn aon deacracht agat aon cheann de na gníomhaíochtaí seo a leanas a dhéanamh? Ní(a) Gléasadh, folcadh nó dul Bíonn bhíonn timpeall laistigh den bhaile

(b) Dul amach ón mbaile i Ní d’aonar chun siopadóireacht Bíonn bhíonn a dhéanamh nó chun cuairt a thabhairt ar an dochtúir

(c) Obair a dhéanamh i bpost Ní nó i ngnó nó freastal a Bíonn bhíonn dhéanamh ar scoil nó coláiste

(d) Páirt a ghlacadh i ngníomhaíochtaí Ní eile, mar shampla siamsaíocht Bíonn bhíonn nó córas iompair a úsáid

Conas atá do shláinte ghinearálta?


1 An-mhaith

2 Go maith

3 Réasúnta

4 Go dona

5 An-dona

Cén ghnáthchóir thaistil chun oibre, chun scoile nóchun coláiste atá agat?

Marcáil in aon bhosca amháin, don chuid is faide, de réir achair, de do ghnáth-thuras chun oibre, chun scoile nó chun coláiste.

Gan a bheith ag obair, ar scoil nó coláiste

De shiúl na gcos

Rothar

Bus, mionbhus nó cóiste

Traein, DART nó LUAS

Gluaisrothar nó scútar

Gluaisteán (tiománaí)

Gluaisteán (paisinéir)

Veain

Eile, leoraí san áireamh

Oibríonn ag baile nó ón mbaile go príomha

Cén t-am de ghnáth a fhágann tú an baile chun dul chun oibre,chun scoile nó chun coláiste?

1 Gan a bheith ag obair, ar scoil nó coláiste

2 Roimh 06.30

3 06.30 - 07.00

4 07.01 - 07.30

5 07.31 - 08.00

6 08.01 - 08.30

7 08.31 - 09.00

8 09.01 - 09.30

9 I ndiaidh 09.30

Cá fhad a thógann an turas chun oibre, chun scoile nócoláiste de ghnáth?

Sonraigh i nóiméid.

An soláthraíonn tú cúnamh pearsanta rialta gan phá do chara nó do bhall den teaghlach a bhfuil breoiteacht, fadhb shláintenó míchumas fadtéarmach aige/aici?Áirigh fadhbanna de bharr seanaoise.Áirítear i gcúnamh pearsanta cúnamh le buntascanna mar bheathú nó gléasadh. 1 Soláthraíonn

2 Ní sholáthraíonn

Má ‘Sholáthraíonn’, cé mhéad uair satseachtain atá i gceist?

Sonraigh in uaireanta.

Cad é an leibhéal is airde oideachais/traenála (lánaimseartha nó páirtaimseartha) atá críochnaithe agat go dtí seo?


Gan aon oideachas/traenáil fhoirmiúil

Bunoideachas CNC Leibhéil 1 nó 2 Teastas CDBO Leibhéil 1 nó 2, nó a choibhéis

Iar-bhunoideachas Íochtair CNC Leibhéal 3 Teastas Sóisearach/Meánteist/Teastas Grúpa, Teastas CDBO Leibhéil 3 Bunscileanna FÁS, Bunteastas CNCG, nó a choibhéis

Iar-bhunoideachas Uachtair CNC Leibhéil 4 nó 5 Ardteist. (lena n-áirítear Cláir Fheidhmeacha agus Gairmchúrsaí) nó a coibhéis

Cáilíocht Theicniúil nó Gairmchúrsa CNC Leibhéil 4 nó 5 Teastas CDBO Leibhéil 4/5, CNCG Leibhéil 1/2 Sainscileanna FÁS, Teastas Talmhaíochta Teagaisc, Teastas Ceardaíochta CERT, nó a choibhéis Ardteastas/Printíseacht Chríochnaithe CNC Leibhéal 6 Ardteastas CDBO, CNCG Leibhéal 3, Teastas Náisiúnta Ceardaíochta FÁS, Teastas Feirmeoireachta Teagaisc, Teastas i gCócaireacht Phroifisiúnta CERT nó a choibhéis

Ardteastas CNC Leibhéal 6 Teastas Náisiúnta CNCO/CDAO nó a choibhéis

Gnáthchéim Bhaitsiléara nó Dioplóma Náisiúnta CNC Leibhéal 7

Céim Bhaitsiléara Onóracha/Cáilíocht Phroifisiúnta nó an dá cheann CNC Leibhéal 8

Dioplóma nó Céim Iarchéime CNC Leibhéal 9 Dioplóma Iarchéime, Céim Mháistir nó a coibhéis

Dochtúireacht (Ph.D) nó níos airde CNC Leibhéal 10

Má tá tú faoi 15 bliana d’aois

Téigh chuig C34

An bhfuil tú scortha ón oideachas lánaimseartha?

1 Tá

2 Níl

Má ‘Tá’, sonraigh an AOIS nuair a scoireadh.

15

16

17

18

19

20

21

22

23

24

25

1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

6

7

8

9

10

11

Foirm Theaghlaigh

GH05


Cad é príomhréimse staidéir nacáilíochta is airde atá críochnaitheagat go dáta?

Gan cháilíochtaí dara leibhéil san áireamh.

Scríobh isteach réimse an staidéir.

(e.g. CUNTASAÍOCHT, TEIRIPE ÁILLEACHTA,FEIRMEOIREACHT, PLUIMÉIREACHT)

26

Conas a chuirfeá síos ar dophríomhstádas faoi láthair?


1 Ag obair le haghaidh íocaíochta nó brabúis

2 Ag lorg oibre rialta don chéad uair

3 Dífhostaithe

4 Mac léinn nó dalta

5 Cúraimí tí/teaghlaigh

6 Scortha ón bhfostaíocht

7 Gan a bheith in ann oibriú de bharr tinnis nó míchumais bhuan

8 Eile, sonraigh

27

Má tá tú ag obair,dífhostaithe nó ar scor

Más mac léinn thú

Nó eile

Téigh chuig C2928

Téigh chuig C34

Téigh chuig C35

An oibríonn (ar oibrigh) tú mar fhostaí nó an bhfuil (an raibh) tú féin-fhostaithe i do phríomhphost?

Is é do phríomhphost an post ina n-oibríonn (ar oibrigh) tú an chuid is mó uaireanta an chloig de ghnáth.


1 Fostaí

2 Féin-fhostaithe, le fostaithe íoctha

3 Féin-fhostaithe, gan fostaithe íoctha

4 Ag cabhrú le gaol (gan phá ná tuarastal cinnte á fháil)

29

Cén tslí bheatha atá (a bhí) agat i do phríomhphost?

I ngach cás, cuir síos ar an tslí bheatha ina hiomláine agus go beacht, tabhairteideal iomlán an phoist.

Úsáid téarmaí beachta mar NÁ hÚSÁID téarmaí ginearálta mar BAINISTEOIR SIOPA MIONDÍOLA BAINISTEOIR MÚINTEOIR MEÁNSCOILE MÚINTEOIR INNEALTÓIR LEICTREACH INNEALTÓIR Ba chóir do Státseirbhísigh agus fostaithe rialtais áitiúil a ngrád a lua e.g.OIFIGEACH SINSEARACH RIARCHÁIN. Féadfaidh baill den Gharda Síochána nó den Arm a gcéim a lua. Ba chóir go luafadh múinteoirí a mbrainse múinteoireachtae.g. BUNMHÚINTEOIR. Ba chóir go dtabharfadh an cléir agus oird chráifeachta tuairisc iomlán e.g. BEAN RIALTA, BANALTRA GHINEARÁLTA CHLÁRAITHE.

Sonraigh do phríomh-SHLÍ BHEATHA.

Más feirmeoir, sonraigh MÉID limistéar na feirme go dtí an heicteár is giorra.

Héicteáir

30

Cén gnó atá (a bhí) ag d’fhostóir ag an ionad a n-oibríonn (ar oibrigh)tú i do phríomhphost?

Má tá (bhí) tú féinfhostaithe freagair i dtaca le do ghnó féin.Déan cur síos ar an bpríomhtháirge nó seirbhís a sholáthraíonn d’fhostóir. Mar shampla, DÉANANN RÍOMHAIRÍ, DEISÍONN GLUAISTEÁIN,MEÁNOIDEACHAS, MÓRDHÍOL BIA, DÉANANN CÓGAIS,CONRADHGHLANTACHÁN, FORBAIRT AGUS TACAÍOCHT BOGEARRAÍ.

32

Má tá tú scortha Téigh chuig C3531

Má tá tú dífhostaithe Téigh chuig C3533

Céard é AINM IOMLÁN agus SEOLADH d’áit oibre, do scoile nó coláiste?34Ainm Iomlán

Seoladh

1 Oibríonn ag baile nó ó bhaile go príomha 2 Gan aon ionad oibre seasta

Freagair ceisteanna do Dhuine 2 ag tosú ar an gcéad leathanach eile.Muna bhfuil ach duine amháin i láthair sa teaghlach ar oíche an 10 Aibreán Téigh chuig leathanach 22

35


GH06



2 Gnéas


Cén gaol atá agat le Duine 1?

Marcáil in aon bhosca amháin. Gaol ag Duine DUINE 2 le 1

Fear céile nó bean chéile 1

Páirtí (páirtí den ghnéas 2 céanna san áireamh)

Mac nó iníon 3

Leasleanbh 4

Deartháir nó deirfiúr 5

Máthair nó athair 6

Seantuismitheoir 7

Leasmháthair/leasathair 8

Cliamhain nó 9 banchliamhain

Garleanbh 10

Gaol eile 11

Duine nach gaol (lena 12 n-áirítear páiste altrama)








6 Colscartha

7 Baintreach

4

5




6






1 Seoladh CÉANNA




1 Bhí 2 Ní raibh


AGUS



1 Éireannach




A Cine Geal

1 Éireannach




4 Afraiceach



6 Síneach



8 Eile, sonraigh



1 Duine ar bith


1 Caitliceach


3 Ioslamachas

4 Preispitéireach

5 Ceartchreidmheach




1 Tá

2 Níl




3 Go seachtainiúil





GH07



1 Labhraíonn

2 Ní Labhraíonn

Cén teanga í sin?




1 An-mhaith

2 Go maith

3 Go dona

4 Ní labhraíonn

Leathanach 8
















1 An-mhaith

2 Go maith

3 Réasúnta

4 Go dona

5 An-dona




De shiúl na gcos

Rothar






Veain





2 Roimh 06.30

3 06.30 - 07.00

4 07.01 - 07.30

5 07.31 - 08.00

6 08.01 - 08.30

7 08.31 - 09.00

8 09.01 - 09.30

9 I ndiaidh 09.30




















Téigh chuig C34


1 Tá

2 Níl


15

16

17

18

19

20

21

22

23

24

25

1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

6

7

8

9

10

11

Foirm Theaghlaigh

GH08






26





3 Dífhostaithe





8 Eile, sonraigh

27



Nó eile

Téigh chuig C2928

Téigh chuig C34

Téigh chuig C35




1 Fostaí




29






Héicteáir

30



32




Seoladh


Freagair ceisteanna do Dhuine 3 ag tosú ar an gcéad leathanach eile.Muna bhfuil ach beirt i láthair sa teaghlach ar oíche an 10 Aibreán Téigh chuig leathanach 22

35


GH09



2 Gnéas


Cén gaol atá agat le Daoine 1 agus 2?

Marcáil in aon bhosca amháin do gach duine.

Gaol ag Daoine DUINE 3 le 1 2



Mac nó iníon 3

Leasleanbh 4



Seantuismitheoir 7



Garleanbh 10

Gaol eile 11









6 Colscartha

7 Baintreach

4

5




6






1 Seoladh CÉANNA




1 Bhí 2 Ní raibh


AGUS



1 Éireannach




A Cine Geal

1 Éireannach




4 Afraiceach



6 Síneach



8 Eile, sonraigh



1 Duine ar bith


1 Caitliceach


3 Ioslamachas

4 Preispitéireach

5 Ceartchreidmheach




1 Tá

2 Níl




3 Go seachtainiúil





GH10



1 Labhraíonn

2 Ní Labhraíonn

Cén teanga í sin?




1 An-mhaith

2 Go maith

3 Go dona

4 Ní labhraíonn

Leathanach 11
















1 An-mhaith

2 Go maith

3 Réasúnta

4 Go dona

5 An-dona




De shiúl na gcos

Rothar






Veain





2 Roimh 06.30

3 06.30 - 07.00

4 07.01 - 07.30

5 07.31 - 08.00

6 08.01 - 08.30

7 08.31 - 09.00

8 09.01 - 09.30

9 I ndiaidh 09.30




















Téigh chuig C34


1 Tá

2 Níl


15

16

17

18

19

20

21

22

23

24

25

1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

6

7

8

9

10

11

Foirm Theaghlaigh

GH11






26





3 Dífhostaithe





8 Eile, sonraigh

27



Nó eile

Téigh chuig C2928

Téigh chuig C34

Téigh chuig C35




1 Fostaí




29






Héicteáir

30



32




Seoladh


Freagair ceisteanna do Dhuine 4 ag tosú ar an gcéad leathanach eile.Muna bhfuil ach triúr i láthair sa teaghlach ar oíche an 10 Aibreán Téigh chuig leathanach 22

35


GH12



2 Gnéas


Cén gaol atá agat le Daoine 1, 2 agus 3?


Gaol ag Daoine DUINE 4 le 1 2 3



Mac nó iníon 3

Leasleanbh 4



Seantuismitheoir 7



Garleanbh 10

Gaol eile 11









6 Colscartha

7 Baintreach

4

5




6






1 Seoladh CÉANNA




1 Bhí 2 Ní raibh


AGUS



1 Éireannach




A Cine Geal

1 Éireannach




4 Afraiceach



6 Síneach



8 Eile, sonraigh



1 Duine ar bith


1 Caitliceach


3 Ioslamachas

4 Preispitéireach

5 Ceartchreidmheach




1 Tá

2 Níl




3 Go seachtainiúil





GH13



1 Labhraíonn

2 Ní Labhraíonn

Cén teanga í sin?




1 An-mhaith

2 Go maith

3 Go dona

4 Ní labhraíonn

Leathanach 14
















1 An-mhaith

2 Go maith

3 Réasúnta

4 Go dona

5 An-dona




De shiúl na gcos

Rothar






Veain





2 Roimh 06.30

3 06.30 - 07.00

4 07.01 - 07.30

5 07.31 - 08.00

6 08.01 - 08.30

7 08.31 - 09.00

8 09.01 - 09.30

9 I ndiaidh 09.30




















Téigh chuig C34


1 Tá

2 Níl


15

16

17

18

19

20

21

22

23

24

25

1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

6

7

8

9

10

11

Foirm Theaghlaigh

GH14






26





3 Dífhostaithe





8 Eile, sonraigh

27



Nó eile

Téigh chuig C2928

Téigh chuig C34

Téigh chuig C35




1 Fostaí




29






Héicteáir

30



32




Seoladh


Freagair ceisteanna do Dhuine 5 ag tosú ar an gcéad leathanach eile.Muna bhfuil ach ceathrar i láthair sa teaghlach ar oíche an 10 Aibreán Téigh chuig leathanach 22

35


GH15



2 Gnéas


Cén gaol atá agat le Daoine 1, 2, 3 agus 4?


Gaol ag DaoineDUINE 5 le 1 2 3 4


Páirtí (páirtí den ghnéas 2céanna san áireamh)

Mac nó iníon 3

Leasleanbh 4



Seantuismitheoir 7



Garleanbh 10

Gaol eile 11

Duine nach gaol (lena 12n-áirítear páiste altrama)








6 Colscartha

7 Baintreach

4

5




6






1 Seoladh CÉANNA




1 Bhí 2 Ní raibh


AGUS



1 Éireannach




A Cine Geal

1 Éireannach




4 Afraiceach



6 Síneach



8 Eile, sonraigh



1 Duine ar bith


1 Caitliceach


3 Ioslamachas

4 Preispitéireach

5 Ceartchreidmheach




1 Tá

2 Níl




3 Go seachtainiúil





GH16



1 Labhraíonn

2 Ní Labhraíonn

Cén teanga í sin?




1 An-mhaith

2 Go maith

3 Go dona

4 Ní labhraíonn

Leathanach 17
















1 An-mhaith

2 Go maith

3 Réasúnta

4 Go dona

5 An-dona




De shiúl na gcos

Rothar






Veain





2 Roimh 06.30

3 06.30 - 07.00

4 07.01 - 07.30

5 07.31 - 08.00

6 08.01 - 08.30

7 08.31 - 09.00

8 09.01 - 09.30

9 I ndiaidh 09.30




















Téigh chuig C34


1 Tá

2 Níl


15

16

17

18

19

20

21

22

23

24

25

1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

6

7

8

9

10

11

Foirm Theaghlaigh

GH17






26





3 Dífhostaithe





8 Eile, sonraigh

27



Nó eile

Téigh chuig C2928

Téigh chuig C34

Téigh chuig C35




1 Fostaí




29






Héicteáir

30



32




Seoladh


Freagair ceisteanna do Dhuine 6 ag tosú ar an gcéad leathanach eile.Muna bhfuil ach cúigear i láthair sa teaghlach ar oíche an 10 Aibreán Téigh chuig leathanach 22

35


GH18



2 Gnéas


Cén gaol atá agat le Daoine 1, 2, 3 agus 4?


Gaol ag DaoineDUINE 6 le 1 2 3 4



Mac nó iníon 3

Leasleanbh 4



Seantuismitheoir 7



Garleanbh 10

Gaol eile 11









6 Colscartha

7 Baintreach

4

5




6






1 Seoladh CÉANNA




1 Bhí 2 Ní raibh


AGUS



1 Éireannach




A Cine Geal

1 Éireannach




4 Afraiceach



6 Síneach



8 Eile, sonraigh



1 Duine ar bith


1 Caitliceach


3 Ioslamachas

4 Preispitéireach

5 Ceartchreidmheach




1 Tá

2 Níl




3 Go seachtainiúil





GH19



1 Labhraíonn

2 Ní Labhraíonn

Cén teanga í sin?




1 An-mhaith

2 Go maith

3 Go dona

4 Ní labhraíonn

Leathanach 20
















1 An-mhaith

2 Go maith

3 Réasúnta

4 Go dona

5 An-dona




De shiúl na gcos

Rothar






Veain





2 Roimh 06.30

3 06.30 - 07.00

4 07.01 - 07.30

5 07.31 - 08.00

6 08.01 - 08.30

7 08.31 - 09.00

8 09.01 - 09.30

9 I ndiaidh 09.30




















Téigh chuig C34


1 Tá

2 Níl


15

16

17

18

19

20

21

22

23

24

25

1

2

3

4

5

6

7

8

9

10

11

1

2

3

4

5

6

7

8

9

10

11

Foirm Theaghlaigh

GH20






26





3 Dífhostaithe





8 Eile, sonraigh

27



Nó eile

Téigh chuig C2928

Téigh chuig C34

Téigh chuig C35




1 Fostaí




29






Héicteáir

30



32




Seoladh


Má tá níos mó ná seisear i láthair sa teaghlach oíche Dé Domhnaigh10 Aibreán beidh Foirm Phearsan Aonair uait do gach duine breise. Iarr ar d’Áirtheoir foirmeacha breise a chur ar fáil duit.Nó eile, téigh chuig an gcéad leathanach eile

35


GH21

Daoine as Láthair a bhfuil gnáthchónaí sa teaghlach orthu

A1 Cad is ainm don duine?Céad ainm agus sloinne.

A4 Cén gaol atá ag an duine seo leDuine 1 ar leathanach 4?


Fear céile nó bean chéile

Páirtí (páirtí den ghnéas céanna san áireamh)

Mac nó iníon

Gaol eile, sonraigh an GAOL

Duine nach gaol (lena n-áirítear páiste altrama)

Freagair ceisteanna A1 go A8 do gach ball den teaghlach a chónaíonn ag an seoladh seo de ghnáth ach NACH bhfuil i láthair oíche Dé Domhnaigh 10 Aibreán. Áirigh ach go háirithe daltaí bunscoile, meánscoile agus mic léinn tríú leibhéil atá ina gcónaí as baile le linn tréimhse téarma NACH bhfuil i láthair ag an seoladh seo oíche Dé Domhnaigh 10 Aibreán.

Duine as Láthair 1

A2 Gnéas


A3 Cad é dáta breithe an duine seo? Lá Mí Bliain

A5 Cad é stádas pósta reatha an duine seo?Freagair má tá an duine seo 15 bliana d’aois nó níos sine.Marcáil in aon bhosca amháin.


2 Pósta (lena n-áirítear athphósta)


6 Colscartha

7 Baintreach

A6 Cá fhad san iomlán atá an tréimhse atá an duine seo le bheith as baile?

1 Níos lú ná 12 mí

2 12 mí nó níos mó

A7 An raibh an duine seo i bPoblacht na hÉireann Dé Domhnaigh 10 Aibreán?

1 Bhí

2 Ní raibh

A8 An mac léinn/dalta an duine seo atá as baile ag freastal ar scoil nó ar choláiste?

1 Is ea

2 Ní hea






Mac nó iníon



Duine as Láthair 2

A2 Gnéas







6 Colscartha

7 Baintreach





1 Bhí

2 Ní raibh


1 Is ea

2 Ní hea






Mac nó iníon



Duine as Láthair 3

A2 Gnéas







6 Colscartha

7 Baintreach




A7


1 Is ea

2 Ní hea

Leathanach 22

1

2

3

11

12

1

2

3

11

12

1

2

3

11

12

Foirm Theaghlaigh

An raibh an duine seo i bPoblacht na hÉireann Dé Domhnaigh 10 Aibreán?

1 Bhí

2 Ní raibh

GH22

Duine as Láthair 4 Dearbhú






Mac nó iníon



A2 Gnéas







6 Colscartha

7 Baintreach





1 Bhí

2 Ní raibh


1 Is ea

2 Ní hea

Sula síníonn tú an dearbhú seiceáil an méad seo a leanas le do thoil:

• Go bhfuil na ceisteanna maidir le do chóiríocht ar leathanach 2 comhlánaithe agat.

• Go bhfuil gach uile dhuine (lena n-áirítear cuairteoirí) a chaith oíche Dé Domhnaigh 10 Aibreán ag an seoladh seo áirithe agat ar Liosta 1 ar leathanach 3.

• Go bhfuil gach uile cheist ba chóir a fhreagairt le haghaidh gach duine a chaith oíche Dé Domhnaigh 10 Aibreán sa teaghlach freagartha agat (leathanaigh 4-21).

• Go bhfuil gach uile dhuine a bhfuil gnáthchónaí orthu ag an seoladh seo ach a bhí as baile go sealadach oíche Dé Domhnaigh 10 Aibreán áirithe agat ar Liosta 2 ar leathanach 3.

• Go bhfuil na ceisteanna ar fad ar leathanaigh 22-23 do gach uile bhall den teaghlach a bhí as baile go sealadach oíche Dé Domhnaigh 10 Aibreán freagartha.

• Nach bhfuil aon duine curtha san áireamh faoi dhó ar an bhfoirm.

Má tá níos mó ná ceathrar as láthairgo sealadach ón teaghlach oíche DéDomhnaigh 10 Aibreán, iarr comhairlear d’Áiritheoir le do thoil.

Dearbhú le comhlánú ag an duine atá freagrach as an bhfoirm a chomhlánú.

Dearbhaím go bhfuil an fhoirm seo ceart agus iomlán a mhéad is eol dom agus a chreidim.

Síniú

Tá an Fhoirm Dhaonáirimh comhlánaithe anois agat.

Go raibh maith agat as do chomhoibriú.

1

2

3

11

12


GH23

Leathanach 24

Nótaí Mínithe

Ceist H3 – An bhfuil do theaghlach mar úinéir ar an gcóiríocht nó an bhfuil sé ar cíos?Má tá do chóiríocht ar cíos (bosca 3), nó má tá tú i do chónaí ann saor ó chíos (bosca 4), ba cheart duit an dara chuid den cheist ‘cé hé do thiarna talún?’ a fhreagairt. Roghnaighan bosca cuí (1, 2 nó 3) le taispeáint an‘Tiarna Talún Príobháideach’, ‘Údarás Áitiúil’ nó ‘Eagraíocht deonach/comharchumann tithíochta’, é do thiarna talún is cuma cé acu a n-íocann nó nach n-íocann tú an cíos ar fad nó cuid de thú féin, nó an bhfuil sé íoctha ar do shon ag FSS nó ag aon eagraíocht eile.

Ceist H4 – Má tá do chóiríocht ar cíos, cé mhéad cíosa a íocann do theaghlach?Má íocann FSS nó aon eagraíocht eile cuid den chíos, ní ceart ach an méad a íocann an teaghlach a chur isteach. Cuir isteach an méad go dtí an Euro is gaire agus marcáilan bosca cuí don tréimhse clúdaithe. Mar shampla, má íocann do theaghlach cíos seachtainiúil de €78.60 cuir isteach €79 agus marcáil bosca 1. Má tá an cíos iomlán íoctha ar do shon cuir isteach 0 agus marcáil bosca 1.

Ceist 4 – GaolTá ceist an ghaoil curtha le chéile le clainne taobh istigh de theaghlaigh a aimsiú. San áireamh anseo tá cásanna ina bhfuil dhá chlann nó níos mó in aon teaghlach amháin.Mar shampla, bheadh teaghlach ina bhfuiliníon fásta suas ina cónaí lena beirttuismitheoirí agus a leanbh féin aici curtha san áireamh mar theaghlach le dhá chlann.

Sa sampla thíos léirítear conas gur ceart an cheist seo a fhreagairt don leanbh sa chás seo, áit gurb iad na tuismitheoirí Daoine 1 agus 2 ar an bhfoirm, an iníon fásta suas Duine 3 agus an leanbh Duine 4.


Gaol DaoineDUINE 4 le 1 2 3



Mac nó iníon 3

Leasleanbh 4



Seantuismitheoir 7


Cliamhain nó banchliamhain 9

Garleanbh 10

Gaol eile 11


Ceist 7 – Cá bhfuil gnáthchónaí ort?Baineann an cheist seo le do ghnátháit chónaithe ag am an Daonáirimh. Má bhí cónaí ort ag an seoladh seo le tréimhse leanúnaí bliana ar a laghad roimh Oíche an Daonáirimh, nó má tháinig tú chuig anseoladh seo sa tréimhse bliana roimh Oíche an Daonáirimh agus é i gceist agat fanacht ar feadh bliana ar a laghad ba cheart duit marc a chur i mbosca 1 (ANSEO). Munabhfuil do ghnátháit chónaithe anseo ach mátá sé in áit eile in Éirinn (Tuaisceart Éireannsan áireamh) ba cheart duit bosca 2 a mharcáil agus do sheoladh iomlán a scríobh isteach. Má tá do ghnátháit chónaithe in áit eile thar lear ba cheart duit bosca 3 a mharcáil agus an tír ghnáthchónaithe a lua.

Mar threoir ghinearálta is ionann gnátháit chónaithe an duine agus an áit a chaitheann sé/sí an chuid is mó dá scíth oíche laethúil. Tugtar na treoracha faoi leith seo a leanas freisin:

• Ba cheart do dhaoine atá as láthair ón teaghlach i rith na seachtaine agus a thagann ar ais chuig an teaghlach ag an deireadh seachtaine baile an teaghlaigh a áireamh mar ghnátháit chónaithe.

• Ba cheart do scoláirí bunscoile agus meánscoile atá as baile ag scoil chónaithe agus mic léinn tríú leibhéil atá as baile ag freastal ar choláiste nó ollscoil baile an teaghlaigh a áireamh mar a ngnátháit chónaithe.

• Má tá 12 mí nó níos mó caite ag duine nó má tá sé ar intinn aige/aici 12 mí nó níos mó a chaitheamh in institiúid is í an institiúid gnátháit chónaithe an duine sin.

• Má chónaíonn duine go rialta i níos mó ná áit chónaithe amháin i rith na bliana ba cheart an áit a chaitheann sé/sí an chuid is mó den bhliain a roghnú mar ghnátháit chónaithe.

Ceist 8 – Cá raibh gnáthchónaí ort bliain ó shin?Baineann an cheist seo le daoine atá bliain d’aois nó níos sine. Baineann na treoracha do Cheist 7 leis an gceist seo freisin. Má bhí gnáthchónaí ort bliain roimh an Daonáireamh san áit chéanna ina bhfuil cónaí anois ort ba cheart duit marc a chur i mbosca 1 (seoladh CÉANNA le anois).

Ceist 9 – An raibh cónaí ort taobh amuigh de Phoblacht na hÉireann ar feadh tréimhse leanúnaí de bhliain nó níos mó?Baineann an cheist seo le daoine atá bliain d’aois nó níos sine. Má tá do ghnátháit chónaithe i bPoblacht na hÉireann agus má rugadh:

• sa tír seo thú agus má bhí cónaí ort taobh amuigh de ar feadh tréimhse leanúnaí de bhliain nó níos mó, nó

• rugadh thar lear agus a bhí ina c(h)ónaí taobh amuigh d’Éirinn ar feadh tréimhse leanúnaí bliana nó níos mó,

ba cheart duit marc a chur i mbosca 1 (Bhí). Ba cheart duit freisin an bhliain deireanach inár tháinig tú chun cónaithe sa tír seo a scríobh isteach agus an tír ina raibh cónaí ort roimhe a lua.

Ceist 15 – An labhraíonn tú teanga seachas Béarla nó Gaeilge sa bhaile?Muna labhraíonn tú teanga seachas Béarla nó Gaeilge sa bhaile ba cheart duit marc a chur i mbosca 2 (Ní labhraíonn) agus téigh ar aghaidh chuig Ceist 16. Ciallaíonn seo nach gá do dhaoine a labhraíonn Béarla agus/nó Gaeilge amháin sa bhaile a gcumas i labhairt an Bhéarla a thuairisciú.

Ceist 16 – An bhfuil aon cheann de na riochtaí fadtéarmacha seo a leanas ort?Ar mhaithe leis an gceist seo is ionann riocht nó deacracht fadtéarmach agus riocht a mhair nó gur dóigh go mairfidh sé ar feadh 6 mhí nó níos faide, nó a ath-tharlaíonn go rialta.

Ceist 22 – An soláthraíonn tú cúnamh pearsanta rialta gan phá do chara nó do bhall den teaghlach a bhfuilbreoiteacht, fadhb shláinte nó míchumas fadtéarmach aige/aici?Má sholáthraíonn tú cúnamh rialta gan phá mar churamaí, is cuma an bhfaigheann nó nach bhfaigheann tú Liúntas/Sochar Cúramóra, ba cheart marc a chur i mbosca 1 (Soláthraíonn) agus scríobh isteach líon na n-uaireanta sa tseachtain a sholáthraíonn tú cúnamh.

Ceist 25 – Cad é an leibhéal is airde oideachais/traenála (lánaimseartha nó páirtaimseartha) atá críochnaithe agat go dtí seo?Leanann na rannóga a luaitear sa cheist seo Creatoibre Náisiúnta na gCáilíochtaí(CNC). Tá tuilleadh eolais ar fáil ag www.nfq.ie

Is féidir tuilleadh eolais maidir le CDBO, CDAO, cáilíochtaí eachtrannacha agus gachcáilíocht eile go ginearálta a fháil agwww.census.ie

Ceist 26 – Cad é príomhréimse staidéir na cáilíochta is airde atá críochnaithe agat go dáta?Tá an cheist seo ann le heolas a bhailiú ar cháilíochtaí iar-mheánscoile amháin. Má tá roinnt cáilíochtaí agat, ní ceart ach an réimse staidéir a bhaineann leis an gcáilíocht is airde atá críochnaithe agat a lua.

Ceist 27 – Conas a chuirfeá síos ar do phríomhstádas faoi láthair?Ní ceart duit ach aon bhosca amháin a mharcáil leis an rannóg a cheapann tú is fearr a chuireann síos ar do phríomhstádas faoi láthair a roghnú. Má tá tú ar shaoire tinnis nó ar shaoire mháithreachais agus é i gceist agat filleadh ar an obair ag am éigin ba cheart duit marc a chur i mbosca 1 (Ag obair).

Ceist 34 – Seoladh d’áit oibre, scoile nó coláisteBa cheart do dhaoine a fhágann an baile le freastal ar obair, scoil nó coláiste ainm agus seoladh iomlán na háite seo a chur ar fáil.

Maidir le leanaí a fhreastalaíonn ar áiseanna réamhscoile (mar shampla, naíolann nó naíon-ra) taobh amuigh den bhaile, ba cheart don duine atá ag comhlánú na foirme ainm agus seoladh iomlán na háise seo a lua.

Foirm Theaghlaigh

GH24

Daonáireamh na hÉireann Census of Population of Ireland ...

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